Hypothalamo-pituitary-adrenal axis dysfunction as a contributory factor to chronic pain and depression

Abstract

Chronic pain and depressive illness are variably resistant to treatment with current pharmacologic therapies. Pain as a reflex sensory response is accompanied by a fast autonomic and delayed neuroendocrine response mediated by the sympathoadrenal and hypothalamo-pituitary-adrenal (HPA) axis, respectively. The emotional aspect of the pain response is encoded by corticolimbic systems (including the HPA axis) to encapsulate the relationship between pain, memory, and mood. These same systems contribute to the symptomatology of depression, a common symptom of which is pain. Conversely, many chronic pain patients may suffer from depressive illness, which appears to develop as a consequence of chronic pain. A comparison of key changes in HPA function after chronic stress in animals with clinical depression in humans, reveals some striking similarities. In this article, the role of the HPA axis in the etiology of chronic pain and depression is discussed.

Restless Legs Syndrome in Patients with Irritable Bowel Syndrome: Response to Small Intestinal Bacterial Overgrowth Therapy

“…Small intestinal bacterial overgrowth may be a common denominator for these disorders, which are characterized by visceral hypersensitivity, chronic inflammation, and neurochemical changes [15]. Altered genetic control of immune activation, production of proinflammatory cytokines, increased intestinal permeability, and immune responses triggered by bacterial endotoxins may lead to the development of intestinal and extraintestinal manifestations of IBS [15][16][17][33][34][35]. Persistence of an underlying motility disorder of the migrating motor complex is thought to be responsible for SIBO and GI symptom relapse after antibiotic therapy [15,25].…”

The impact of anxiety and mood disorders on physical disease: The worried not-so-well

“…Depressed subjects are less likely to perceive a sensory stimulus as being more painful compared with nondepressed control subjects [26]. Pain and depression cause similar changes in the hypothalamicpituitary-adrenal (HPA) axis [27]. HPA axis abnormalities and abnormal autonomic responses are more common in patients with central pain conditions (fibromyalgia, IBS) [28].…”

Psychische Komorbidität bei muskuloskelettalen Erkrankungen

“…Systems (HHN-Achse) zu sein, die sich sowohl bei chronischem Schmerz als auch bei Depression findet[31,32].Die Verknüpfung zwischen muskuloskelettalem Schmerz und psychischen Störungen wird darüber hinaus vermutlich auch intermediär vermittelt. Hurwitz und Morgenstern[33] untersuchten zum Beispiel die Hypothese, dass frühe allergische Reaktionen (Asthma, Heuschnupfen) -als Marker für eine entzündliche Aktivierung der HHN-Achse -zu ungünstigen Reaktionen auf Stressoren im späteren Leben führen.…”